state perspectives on mental health - texas council of ...€¦ · june 23, 2016. office of mental...

State Perspectives

on Mental Health

Sonja Gaines

Association Commissioner

Texas Health and Human Services

June 23, 2016

Office of Mental Health Coordination

Legislative Authority

Office of Mental Health Coordination (MHC) created by S.B. 1-83R

(Article II, HHSC Rider 82). The Office has authority to:

• Provide broad oversight on public mental health policy.

• Coordinate the policy and delivery of mental health services

throughout the State of Texas.

• Consult and coordinate with other state agencies, local governments,

and other entities to ensure a strategic, statewide approach to mental

health.

Vision: To ensure that Texas has a unified approach to the delivery of

behavioral health (BH) services that allows all Texans to have access to

care at the right time and place.

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HHS Transformation Organization Chart

Effective Sept. 1, 2016

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Executive

Commissioner

Chief Deputy

Exec. Comm.

MSS

Division

Community

Services

• Aging & Social

• Health & Dev

• IDD & Rehab

• Behavioral Health

Medicaid

& CHIP

• Program

Enrollment

• Operations

• Policy & Program

• Quality

• Health Plan

Monitoring

Access &

Eligibility

• Community

Access

• Eligibility Ops

• Disability

Determination

• Community Care

Eligibility

Veterans’ Services

Mental Health

Coordination

e-Health

Aging Services

HHS System Collaboration MHC Projects

• Mental Health Services through local mental health

authorities (LMHAs)

• Private Purchase Beds

• Youth Empowerment Services Waiver

• Residential Treatment Centers

• 2-1-1

• NorthSTAR Transition Oversight and Coordination

• Medicaid

• 1115 Transformation Waiver

• Peer Support Services

• Mental Health Texas Website

• Mental Health First Aid4

HHS System MHC Policy Collaboration

Department of State Health Services (DSHS)

• Private Purchase Beds: Contract with community hospitals,

county governments, or LMHAs to increase psychiatric

inpatient bed capacity in the community. Upward trend in

utilization since the beginning of fiscal year 2016:

– Average occupancy rate 93.2% as of March 2016

– Mean length of stay of 19.7 days

– 51.6% involuntary admissions

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DSHS Continued

• Youth Empowerment Services (YES) Waiver Statewide Expansion:

Services available to children and young adults under age 21 who are at

risk of hospitalization due to serious emotional disturbance

– As of April 2016 full Medicaid program with LMHAs serving as county hub

– Enrollment increased from 717 served in 2015 to 1,566 served as far in 2016

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46 63167

294

717

1566

0

200

400

600

800

1000

1200

1400

1600

1800

2011 2012 2013 2014 2015 2016

YES Enrollments


Department of Family and Protective Services (DFPS)

• Mental Health Services: Close to 15,000 children in foster

care with mental health needs through contracts with child

placement agencies and partnership with DSHS

• Residential Treatment Centers (RTCs): Joint project with

DSHS to prevent parental relinquishment to Child Protective

Service based solely to obtain mental health treatment of

child

– Expanded to 30 beds in fiscal year 2016 (up from 10 in 2014-15) with

a waiting list of about 20 children

– DSHS partnering with Texas System of Care to provide technical

assistance to RTCs and LMHAs for implementation of Building

Bridges Initiative RTC best practices7


Department of Aging and Disability Services (DADS)

• Intellectual Developmental Disabilities (IDD) Services: Almost

50% of people with IDD also have a dual mental health condition

• DADS-DSHS Mental Health Wellness for Individuals with IDD

Training: Designed to educate direct service workers on BH needs

of people with IDD and co-occurring BH conditions

• Crisis Response: 84th Legislature approved $18 million exceptional

item to bolster crisis response

– DADS provides LMHAs and Local Intellectual and Developmental

Disability Authorities a Needs and Capacity Assessment for services

– Result has increased crisis respite and funding for staff to work with

the mobile crisis response system through the Mobile Crisis Outreach

Team8


Health and Human Services Commission (HHSC)

• 2-1-1: Call centers available statewide to direct and connect

Texans to needed resources such as food, shelter, clothing,

and BH providers

• NorthSTAR: Per legislative directive, HHSC and DSHS are

working to plan a successful transition for NorthSTAR into

the Dallas Medicaid service delivery area by January 1, 2017.

Transition Goals:

– Medicaid clients to receive their BH services through their existing

managed care organization or fee-for-service.

– Indigent population to receive those services from local organizations

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• Medicaid: Major funding stream for BH services in Texas:

medications, counseling, case management, rehabilitation,

crisis, and inpatient

• 1115 Waiver: Texas has 461 projects across Texas focused

on transformative BH approaches: peer services, integrated

health, telehealth, homeless services, veteran services

– BH projects are eligible to earn more than $2.6 billions All Funds

based on project achievement over the five years of the waiver

– As of January 2016, they have received about $1.7 billion

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Notable 1115 Wavier Projects:

• Bluebonnet Trails Community Center: Peer-led Transitional

Housing project targets “super utilizers”

– Provides peer services, housing, other psychosocial supports

• Tarrant County MHMR: Systemic, Therapeutic, Assessment,

Respite and Treatment (SMART) model

– Provides BH crisis prevention and intervention services for individuals with

intellectual and developmental disabilities and/or Autism Spectrum Disorder

with co-occurring behavioral and medical problems

• Austin-Travis County Integral Care (ATCIC): evidence-based

health promotion programming for adults with severe mental

illness in chronic disease management

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Peer Support Services as a Medicaid Benefit

• Peer Support for Adults: Use of unique peer experiences to assist

individuals with serious mental illness into recovery through

coaching and support

– Create workforce of Certified Peer Specialists that will incentivize expansion

of MH providers

• Parent Peer Support for Children and Families: Peers use

unique experiences to assist parents of children with BH conditions

by:

– Engaging family in treatment process

– Modeling self-advocacy skills, providing information, referral, and non-

clinical training

– Supporting engagement in services

– Assisting with identification of natural and informal community support

systems 12

MHC Community Engagement

• Mental Health Texas Website – MentalHealthTX.org: Offer a

one-stop web-based resource point for Texas residents in need of

immediate mental health information and resources to find basic

mental health information and directions

• Mental Health First Aid (MHFA) Training Initiative

– Basic training provides information on risk factors and early

intervention strategies.

– Almost 2,000 state employees trained since 2014.

– 24 trainers currently available for cross-agency trainings to expand

MHFA statewide.

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Current MHC External Projects

• H.B. 1-84R, Article IX, Section 10.04

– Behavioral Health Coordinating Council

– Five-Year Behavioral Health Strategic Plan

– Coordinated Expenditure Report for Fiscal Year 2017

• Texas Veterans + Family Alliance Grant Program

(S.B. 55-84R)

• Certified Community Behavioral Health Clinics (Substance

Abuse and Mental Health Services Administration [SAMHSA]

grant)

• Texas System of Care (SAMHSA grant)

• Behavioral Health Advisory Committee (Section 3.02,

S.B. 200-84R)14

Statewide Behavioral Health Strategic Plan

& Coordinated Expenditure Proposal

H.B. 1-84R (Article IX, Section 10.04) created the Statewide

Behavioral Health Coordinating Council comprised of 18 state

agencies charged with developing a:

• Five-Year Strategic Plan:

– Detailed planned efforts to coordinate behavioral health programs and

services offered by Council agencies to eliminate redundancy; perpetuate

identified, successful models for mental health and substance abuse treatment;

ensure optimal service delivery; and identify and collect comparable data on

results and effectiveness

– Inventory of BH programs and services by Council agencies

– Report of the number of persons served

• Coordinated Expenditure Proposal for Fiscal Year 2017: Description

of how identified appropriations at each agency will be spent in

accordance with and to further the goals of the approved strategic plan. 15

Statewide Behavioral Health

Coordinating Council Members

The Council, includes the Texas Education Agency as a voluntary member, as well as

representation from the following agencies:

• The Office of the Governor

• Texas Veterans Commission

• Health and Human Services Commission

• Department of Aging and Disability Services

• Department of Family and Protective Services

• Department of State Health Services

• Texas Civil Commitment Office

• The University of Texas Health Science Center at Houston

• The University of Texas Health Science Center at Tyler

• Department of Criminal Justice

• Texas Juvenile Justice Department

• Texas Military Department

• Health Professions Council has one seat representing the Texas Medical Board,

Texas Board of Pharmacy, Texas Board of Dental Examiners, Texas Board of

Nursing, Texas Optometry Board, and Texas Board of Veterinary Medical

Examiners16

Statewide Behavioral Health Strategic Plan

& Coordinated Expenditure Proposal

Expected Outcomes

• Significant improvements in BH coordination across state

agencies

• Maximize use of existing resources and services

• Address BH gaps identified through strategic approach

• More efficient and effective state government

• Ensure utilization of successful best, promising, and evidence-

based BH services and service delivery

• Ensure prompt access to quality BH services

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Senate Bill 55: Texas Veterans + Family

Alliance Grant Program

S.B. 55-84R requires HHSC to establish a grant program

to support community mental health programs providing

services and treatment to veterans and their families. • Grant Funds Totaling $21 million

• Expected Outcomes

– Local communities will increase access to mental health care that is safe,

appropriate and timely, of high quality, and respectful of military culture

for Texas veterans and their families.

– Barriers to accessing care, including community stigma, will be reduced.

– Community partnerships will be supported as they develop projects and

integrate services to strengthen their collaborative planning capacity.

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Texas Veterans + Family Alliance

Grant Workload Projections

Phase I: $1 Million Pilot Program (funds identified by

HHSC to support the pilot)

Status: Contracts run through August 31, 2017

• Meadows Mental Health Policy Institute contracted as Pilot Program

Administrator

• HHSC funding awarded: $885,100

– Emergence Health Networks serving El Paso County and Fort Bliss

– United Way of Denton County

– Texas Panhandle Centers serving 30 northern-most counties in Texas

Panhandle

– Center for BrainHealth serving Dallas area

• Local community match: $954,744

• Total estimated veterans and families served: 1,005

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Texas Veterans + Family Alliance

Grant Workload Projections

Phase II: $20 Million Full Program for biennium

appropriated by H.B. 1-84R, Article II, HHSC Rider 68

• Status: Finalizing RFA for posting

– Meadows Mental Health Policy Institute contracted as Full Program

Administrator

– Full grant awards are expected to be announced by end of

Summer 2016

– Grant period is anticipated to be September 1, 2016, to

August 31, 2017

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Federal Grant Supported Activities

Mental Health Related Grants from SAMSHA with allocated

staff to grant activities

• System of Care: Children and adolescent mental health

– Supports Children and Youth Subcommittee

– Contract management and oversight for University of Texas School of

Social Work involvement with grant

– Training and conferences

• Certified Behavioral Health Community Clinics Project: Mental

health services for Medicaid clients

– Interagency Contract management with DSHS

– Contract oversight for prospective payment system development by

outside consultant as part of grant requirements

– Site visits to certified clinics21

Behavioral Health Advisory Committee

Enterprise-wide Behavioral Health Advisory Committee

• S.B. 200-84R established committee; appointed November 2015

• Quarterly meetings began in January 2016

• Incorporates consolidation of certain functions from the following

abolished and reconstituted committees:

– Council for Advising and Planning for the Prevention and Treatment of

Mental Health and Substance Use Disorders

– Drug Demand Reduction Advisory Committee

– Local Authority Network Advisory Committee

– Texas Children Recovering from Trauma Steering Committee

– Texas System of Care Consortium

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Questions?

Sonja Gaines,

Associate Commissioner

for Mental Health Coordination

[email protected]

www.MentalHealthTX.org

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state perspectives on mental health - texas council of ...€¦ · june 23, 2016. office of mental...

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